Abdominal, multi-port and single-port total laparoscopic hysterectomy: eleven-year trends comparison of surgical outcomes complications of 936 cases

作者：Kim Su Mi; Park Eun Kyung; Jeung In Cheul; Kim Chan Joo; Lee Yong Seok^*

来源：Archives of Gynecology and Obstetrics, 2015, 291(6): 1313-1319.

DOI：10.1007/s00404-014-3576-y

• Hysterectomy
• Complication
• Single-port
• Multi-port
• TLH

To compare surgical outcomes and complications of 284 patients who had total abdominal hysterectomy (TAH), 366 patients who had multi-port access total laparoscopic hysterectomy (MPA-TLH), and 286 patients who had single-port access total laparoscopic hysterectomy (SPA-TLH) using a transumbilical single-port system.
A retrospective study was conducted on a cohort of women who underwent TAH, MPA-TLH, or SPA-TLH for benign gynecologic diseases at DaeJeon St. Mary's Hospital, between January 2003 and December 2013. Surgical outcomes and complications were compared between the three groups.
The total operative time (min) was longest in the SPA-TLH group (188.3 +/- A 51.3), followed by the TAH (176.4 +/- A 47.9) and MPA-TLH (149.3 +/- A 59.5) groups (p < 0.05). The estimated blood loss (mL) did not differ between MPA-TLH and SPA-TLH (163.8 +/- A 168.9 vs. 176.9 +/- A 197.8 mL), but it was the greatest in TAH (427.1 +/- A 250.6, p < 0.05). The weight of the uterus (gm) was highest in TAH (375.8 +/- A 380.1, p < 0.05) and similar in MPA-TLH and SPA-TLH (10.1 +/- A 2.6 vs. 9.7 +/- A 2.6 cm). The hospital stay (days) was longest in the TAH (7.0 +/- A 2.1) and SPA-TLH (6.3 +/- A 2.0) groups, followed by the MPA-TLH (5.5 +/- A 2.0) group (p < 0.05). The major complication rate was 2.5 % (7 cases) in the TAH group, 5.5 % (20 cases) in the MPA-TLH group, and 0.7 % (2 cases) in the SPA-TLH group. In the MPA-TLH group, the complication rate of the first half of the cases was significantly higher than in the latter half of cases, especially with regards to vaginal cuff dehiscence (p < 0.05). In the SPA-TLH group, no statistically significant difference was found between the two sub-groups.
Our study showed that MPA-TLH and SPA-TLH were feasible and safe when compared to TAH. Furthermore, after acquiring technical skills in laparoscopic surgery, conversion from MPA-TLH to SPA-TLH might be easier than the initial conversion from laparotomy to laparoscopy. The advantage of SPA-TLH over MPA-TLH is questionable, considering the longer learning curve; however SPA-TLH is an effective alternative for both the patient and surgeon.

• 出版日期2015-6